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ischemic heart
Disease
And
Myocardial infarction
SUBMITTED BY- CHHAYA
WASKALE
• Ischemic heart disease
1. Introduction
2. Etiopathogenesis
3. Risk factors
4. Effectects of myocardial ischemia
Introduction-
 IHD also known as coronary heart disease, coronary
artery disease
 IHD is defined as acute or chronic for cardiac disability
arising from imbalance between myocardial supply and
demand for oxygenated blood
 Since narrowing or obstruction Of coronary artery
system is the most common cause of myocardial
anoxia
Etiopathogenesis -
 It is convenient to consider the etiology of IHD
under there broad headings:
1. Coronary atherosclerosis
2. Superadded changes in coronary atherosclerosis; and
3. Non – atherosclerotic causes
Coronary atherosclerosis -
 Coronary atherosclerosis resulting in fixed obstruction is the major
cause of IHD in more than 90% cases
 Distribution – highest incidence in the anterior descending branch
of left coronary artery, followed in descending frequency by the right
coronary artery and still less in circumflex branch of left coronary
 > 75% occlusion causes symptomatic ischemia included by exercise
 Location – area of severe involvement is 3-4 cms from coronary
ostia, most often at/ near the bifurcation
 Slowly developing atheromas over long periods Lead yo collateral
circulation
Super added changes in coronary
atherosclerosis -
 Acute coronary syndrome are precipitated by
changes superimposed on pre- existing fixed
coronary atheroma
 Haemorrage : causes volume expansion
 Fissuring,ulceration- exposure of highly
thrombogenic subendothelial tissues of blood
 Local platelets aggregation plug – which release
thrombaxaneA2 ( vasospasmic mediator)
responsible for coronary vasospasm
 Thrombosis, emboli,microinfacts
Non-atherosclerotic causes -
 Vasospasm – despite no significant atherosclerotic
coronary narrowing may cause angina / M.I
1. Circulating adrenergic agonist’ s
2. Local released content of platelets
3. Decrease secretion of relaxing factors
 Stenosis of coronary ostia – from syphilitic aortitis
 Arteritis – polyarteritis nodosa, tuberculosis and other
bacterial infection
 Thrombotic disease- sickle cell anaemia ,polycythaemia
vera, : hypercoagulability of blood – coronary occlusion
 Trauma
Risk factors-
 High blood pressure
 Smoking
 Obesity
 High blood cholesterol
 Lack of exercise
 Diabetes
Effects of myocardial ischemia -
CORONAR ARTERY Disease
1. Asymptomatic state
2. Angina pectoris
3. Acute myocardial infarction
4. Chronic ischemic heart disease
5. Sudden cardiac death
MYOCARDIAL INFACTION -
 Introduction
 Types of infarcts
 Epidemiology
 Etiology
 Etiopathogenesis
 Diagnosis
 Complications
INTRODUCTION-
 MI is defined as a diseased condition which is caused
by reduced blood flow in coronary artery due to
atherosclerosis and occlusion of an artery by an
embolus or thrombus
 MI or heart attack is the irreversible damage of
myocardial tissue caused by prolonged ischemia and
hypoxia
Types of infarcts-
 According to anatomic region of left ventricle
involved-
1. Anterior
2. Posterior
3. Lateral
4. Septal
5. Circumferential
6. Combinations-
anterolateral,posterolateral,anteroseptal
 According to degree of thickness of ventricular wall
involved-
1. Transmural ( full thickness)
2. Laminar ( Subendocardial)
 According to age of infarcts-
1. Newly formed ( acute,recent,fresh)
2. Advanced infarcts ( old,healed, organised)
EPIDEMIOLOGY-
 In industrial countries MI accounts of 10-25% of all death’s
 Incidence is higher in elderly people about, 5% occurs at
people under the age 40
 Male have higher risk
 Women during reproductive period have low risk
 Over last 30 years, the rate of disease increase from 2-3
rural population and 4-12% in urban population
ETIOLOGY-
 Tobacco,smoking
 Hypertension
 Drug abuse
 Obesity
 Stress
 Gender
 Diabetes
 Hyperlipoproteinaemia
 Family history of ischemic heart disease
ETIOPATHOGENESIS-
 The etiologic role of severe coronary atherosclerosis ( more than 75% compromise of lumen)
of one or more of the three major coronary arterial trunks in the pathogenesis of about 90%
cases of acute MI is well documented by autopsy studies as well as by coronary angiographic
studies. A few notable features in etiology and pathogenesis of acute MI are considered
below:
1. Mechanism of myocardial ischemia
2. Role of platelets
3. Acute plaque rupture
4. Non- atherosclerotic cause
5. Transmural versus subendocardial infarcts
 Complications
1. Arrhythmias
2. congestive heart failure
3. Cardiogenic shock
4. Mural thrombosis and thromboembolism
DIAGNOSIS-
 Clinical features-
1. Pain – usually sudden,severe,crushing,and
prolonged,substerna in location, often radiating to one or
both the arm’s,neck,and back
2. Indigestion
3. Apprehension- the patient is often terrified,restless and
apprehensive , due to great fear of death
4. Shock
5. Low grade fever ( accomplished by leucocytosis and
elevated ESR
 Serum cardiac markers-:
1. Creatinine phosphokinase( ck) – ck has three
forms :
 CK-MM - derived from skeletal muscle
 CK-BB - derived from brain and lungs
 CK-MB - mainly from cardiac muscles and
insignificant amount from extra cardiac tissue
2. Lactic dehydrogenase
3. Cardiac specific troponins
 ECG changes -:
1. ST segment elevation
2. T wave inversion
3. Appearance of wide deep Q waves
 ischemic heart Disease And_Myocardial infarction.pptx

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ischemic heart Disease And_Myocardial infarction.pptx

  • 2. • Ischemic heart disease 1. Introduction 2. Etiopathogenesis 3. Risk factors 4. Effectects of myocardial ischemia
  • 3. Introduction-  IHD also known as coronary heart disease, coronary artery disease  IHD is defined as acute or chronic for cardiac disability arising from imbalance between myocardial supply and demand for oxygenated blood  Since narrowing or obstruction Of coronary artery system is the most common cause of myocardial anoxia
  • 4.
  • 5. Etiopathogenesis -  It is convenient to consider the etiology of IHD under there broad headings: 1. Coronary atherosclerosis 2. Superadded changes in coronary atherosclerosis; and 3. Non – atherosclerotic causes
  • 6. Coronary atherosclerosis -  Coronary atherosclerosis resulting in fixed obstruction is the major cause of IHD in more than 90% cases  Distribution – highest incidence in the anterior descending branch of left coronary artery, followed in descending frequency by the right coronary artery and still less in circumflex branch of left coronary  > 75% occlusion causes symptomatic ischemia included by exercise  Location – area of severe involvement is 3-4 cms from coronary ostia, most often at/ near the bifurcation  Slowly developing atheromas over long periods Lead yo collateral circulation
  • 7.
  • 8. Super added changes in coronary atherosclerosis -  Acute coronary syndrome are precipitated by changes superimposed on pre- existing fixed coronary atheroma  Haemorrage : causes volume expansion  Fissuring,ulceration- exposure of highly thrombogenic subendothelial tissues of blood  Local platelets aggregation plug – which release thrombaxaneA2 ( vasospasmic mediator) responsible for coronary vasospasm  Thrombosis, emboli,microinfacts
  • 9. Non-atherosclerotic causes -  Vasospasm – despite no significant atherosclerotic coronary narrowing may cause angina / M.I 1. Circulating adrenergic agonist’ s 2. Local released content of platelets 3. Decrease secretion of relaxing factors  Stenosis of coronary ostia – from syphilitic aortitis  Arteritis – polyarteritis nodosa, tuberculosis and other bacterial infection  Thrombotic disease- sickle cell anaemia ,polycythaemia vera, : hypercoagulability of blood – coronary occlusion  Trauma
  • 10. Risk factors-  High blood pressure  Smoking  Obesity  High blood cholesterol  Lack of exercise  Diabetes
  • 11. Effects of myocardial ischemia - CORONAR ARTERY Disease 1. Asymptomatic state 2. Angina pectoris 3. Acute myocardial infarction 4. Chronic ischemic heart disease 5. Sudden cardiac death
  • 12. MYOCARDIAL INFACTION -  Introduction  Types of infarcts  Epidemiology  Etiology  Etiopathogenesis  Diagnosis  Complications
  • 13. INTRODUCTION-  MI is defined as a diseased condition which is caused by reduced blood flow in coronary artery due to atherosclerosis and occlusion of an artery by an embolus or thrombus  MI or heart attack is the irreversible damage of myocardial tissue caused by prolonged ischemia and hypoxia
  • 14.
  • 15. Types of infarcts-  According to anatomic region of left ventricle involved- 1. Anterior 2. Posterior 3. Lateral 4. Septal 5. Circumferential 6. Combinations- anterolateral,posterolateral,anteroseptal
  • 16.  According to degree of thickness of ventricular wall involved- 1. Transmural ( full thickness) 2. Laminar ( Subendocardial)  According to age of infarcts- 1. Newly formed ( acute,recent,fresh) 2. Advanced infarcts ( old,healed, organised)
  • 17. EPIDEMIOLOGY-  In industrial countries MI accounts of 10-25% of all death’s  Incidence is higher in elderly people about, 5% occurs at people under the age 40  Male have higher risk  Women during reproductive period have low risk  Over last 30 years, the rate of disease increase from 2-3 rural population and 4-12% in urban population
  • 18. ETIOLOGY-  Tobacco,smoking  Hypertension  Drug abuse  Obesity  Stress
  • 19.  Gender  Diabetes  Hyperlipoproteinaemia  Family history of ischemic heart disease
  • 20. ETIOPATHOGENESIS-  The etiologic role of severe coronary atherosclerosis ( more than 75% compromise of lumen) of one or more of the three major coronary arterial trunks in the pathogenesis of about 90% cases of acute MI is well documented by autopsy studies as well as by coronary angiographic studies. A few notable features in etiology and pathogenesis of acute MI are considered below: 1. Mechanism of myocardial ischemia 2. Role of platelets 3. Acute plaque rupture 4. Non- atherosclerotic cause 5. Transmural versus subendocardial infarcts  Complications 1. Arrhythmias 2. congestive heart failure 3. Cardiogenic shock 4. Mural thrombosis and thromboembolism
  • 21. DIAGNOSIS-  Clinical features- 1. Pain – usually sudden,severe,crushing,and prolonged,substerna in location, often radiating to one or both the arm’s,neck,and back 2. Indigestion 3. Apprehension- the patient is often terrified,restless and apprehensive , due to great fear of death 4. Shock 5. Low grade fever ( accomplished by leucocytosis and elevated ESR
  • 22.  Serum cardiac markers-: 1. Creatinine phosphokinase( ck) – ck has three forms :  CK-MM - derived from skeletal muscle  CK-BB - derived from brain and lungs  CK-MB - mainly from cardiac muscles and insignificant amount from extra cardiac tissue 2. Lactic dehydrogenase 3. Cardiac specific troponins  ECG changes -: 1. ST segment elevation 2. T wave inversion 3. Appearance of wide deep Q waves